Research Articles

Hazards of Illicit Methamphetamine Production and Efforts at Reduction: Data from the Hazardous Substances Emergency Events Surveillance System

Natalia Melnikova, MD, PhDa ABSTRACT Wanda Lizak Welles, PhDb Rebecca E. Wilburn, MPHb Objectives. Methamphetamine (meth) is a highly addictive drug of abuse that Nancy Rice, MPHc can easily be made in small illegal laboratories from household chemicals that Jennifer Wu, MSa are highly toxic and dangerous. Meth labs have been found in locations such Martha Stanbury, MSPHd as homes, outbuildings, motels, and cars. Its production endangers the “cook,” neighbors, responders, and the environment. This article describes surveil­ lance data used to examine the emergence and public health impacts of illicit clandestine meth labs, as well as two states’ efforts to thwart lab operations and prevent responder injuries. Methods. We analyzed data collected from 2001 to 2008 by 18 states partici­ pating in the Agency for Toxic Substances and Disease Registry’s Hazardous Substances Emergency Events Surveillance (HSEES) Program to examine the occurrence and public health impacts of clandestine meth production. Results. HSEES data indicate that the majority of clandestine meth lab events occurred in residential areas. About 15% of meth lab events required evacua­ tion. Nearly one-fourth of these events resulted in injuries, with 902 reported victims. Most victims (61%) were official responders, and one-third were members of the general public. Since 2004, with the implementation of local and federal laws and prevention activities, the number of meth lab events has declined. Increased education and training of first responders has led to decreased injuries among police officers, firefighters, and emergency medical personnel. Conclusions. HSEES data provided a good data source for monitoring the emergence of domestic clandestine meth production, the associated public health effects, and the results of state and federal efforts to promote actions to address the problem. aCenters for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, Division of Health Studies, Atlanta, GA bNew York State Department of Health, Center for Environmental Health, Division of Environmental Health Assessment, Bureau of Toxic Substance Assessment, National Toxic Substance Incidents Program, Troy, NY cMinnesota Department of Health, Environmental Health Division, Hazardous Substances Emergency Events Surveillance Program, St. Paul, MN dMichigan Department of Community Health, Division of Environmental Health, Lansing, MI Address correspondence to: Natalia Melnikova, MD, PhD, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, Division of Health Studies, 4770 Buford Hwy., MS F-57, Atlanta, GA 30341; tel. 770-488-3697; fax 770-488-7187; e-mail .

116  Public Health Reports / 2011 Supplement 1 / Volume 126 Meth Production Hazards and Reduction Efforts  117

Methamphetamine (meth) is a psychostimulant and MEtHoDS sympathomimetic drug, with medical uses for the treat­ From 1990 to 2009, the Hazardous Substances Emer­ ment of narcolepsy, attention deficit disorders, and gency Events Surveillance (HSEES) Program, estab­ obesity. Long-term meth use has numerous adverse lished by the Centers for Disease Control and Preven­ physical and psychological consequences.1–3 Meth is tion and the Agency for Toxic Substances and Disease a very addictive drug with a high potential for abuse. Registry (ATSDR), collected and analyzed information According to the 2007 National Survey on Drug Use about acute releases of hazardous substances and and Health, approximately 13 million Americans aged threatened releases that resulted in a public health 12 years or older reported using meth at least once action, such as an evacuation. The goal of the program during their lifetime.4 was to use the collected data to identify prevention Unlike drugs such as marijuana or heroin, which strategies that could be implemented to reduce the are derived from plants, meth can be synthesized in frequency of these events and the associated morbid­ clandestine drug laboratories using a variety of easily ity (injury) and mortality (death) experienced by first bought chemicals that are “cooked” with ephedrine- or responders, employees, and the general public. The pseudoephedrine-containing products. The chemi­ ATSDR HSEES Program provided funding to a num­ cals vary depending on the process, but can include ber of state health departments to identify and record anhydrous ammonia, drain cleaners, paint thinner, information on spill/release events occurring in the metallic lithium, hydrochloric or sulfuric acids, starter funded states. An eligible HSEES event was defined fluid, camping fuel, and others. Chemicals found in by ATSDR protocol as any uncontrolled or illegal meth labs are hazardous and toxic. Exposure to the release or threatened release of one or more hazard­ chemicals or by-products can damage the respiratory ous substance(s) (excluding releases of petroleum) in tract, mucous membranes, eyes, and skin. It is relatively a quantity sufficient to require removal, cleanup, or easy for a cook to acquire the chemicals and recipes neutralization according to federal, state, or local law. necessary to make meth.5 Labs have been found in A clandestine drug lab incident was included in the fixed locations—homes, outbuildings, and hotel/ HSEES system if there was an acute release of a hazard­ motel rooms—or in mobile sites, such as trunks of cars, ous substance (i.e., the lab was in operation [“cooking”] motor homes, or moving vans. The processes used to within 72 hours of the lab seizure by law enforcement). make meth can result in fires, explosions, spills, or air Incidents without a known chemical release within the releases of hazardous chemicals, putting the cook and 72-hour period, but with a public health action, such others nearby, including children and responders, at as an evacuation, were also included. risk of injury or death.6–9 States participating in the HSEES Program identified To address the chemical and physical hazards associ­ events from a variety of sources, including state envi­ ated with illicit clandestine labs, federal and state gov­ ronmental conservation or protection agencies, police ernments have passed legislation aimed at decreasing and fire departments, poison control centers, federal the number of meth labs. In 2004, many states began databases (i.e., U.S. Coast Guard National Response applying strong restrictions on sales of ephedrine- and Center and U.S. Department of Transportation Haz­ pseudoephedrine-containing products, which are the ardous Material Information Resource System), hos­ key ingredients in meth production. In September pitals, local media, and others. Some states routinely 2006, the Federal Combat Methamphetamine Epi­ received reports from law enforcement on meth lab demic Act of 2005 restricted the retail sale of ephedrine seizures. Collected information was entered into a and pseudoephedrine products nationwide.10 However, standardized, secure Web-based system maintained illegal meth production and abuse continue to be seri­ by ATSDR. Information recorded included the event ous concerns within the United States and throughout location, the responsible party, the types and quantities the world.11 of chemical(s) involved, primary and secondary causes This article describes the public health impacts of of the release, the number of individuals injured as a clandestine meth production in 18 states that collected result of the release, the types of injuries, the number data on acute releases of hazardous substances. It also of people decontaminated, and the number of people provides information on the actions taken in two states evacuated or sheltered in place. to control illicit meth production and prevent injuries We analyzed retrospective data, 2001–2008 (the lat­ to first responders and bystanders during clandestine est complete year of data), from the HSEES system to lab seizures by law enforcement. identify trends in illegal clandestine meth lab events and in the public health consequences (e.g., morbidity,

Public Health Reports / 2011 Supplement 1 / Volume 126 118  Research Articles mortality, and evacuations). The analysis included Table 1. All HSEES events and clandestine meth lab data collected by the 18 state health departments that events, by year: ATSDR HSEES database, 2001–2008 participated in the HSEES Program at any time from 2001 to 2008. Eleven states (Colorado, Iowa, Louisi­ HSEES events Meth events Meth events Year N N Percent ana, Minnesota, New York, North Carolina, Oregon, Texas, Utah, Washington, and Wisconsin) collected 2001 8,978 297 3.3 information during the entire period. Seven states 2002 9,014 423 4.7 participated at various times during the period (New 2003 9,105 524 5.8 2004 7,744 442 5.7 Jersey: 2001–2008, excluding 2006; Alabama and Mis­ 2005 8,603 300 3.5 sissippi: 2001–2003; Florida and Michigan: 2005–2008; 2006 7,267 180 2.5 Missouri: 2001–2005; and Rhode Island: 2001). 2007 7,947 102 1.3 2008 7,930 105 1.3 Total 66,588 2,373 3.6 RESultS HSEES 5 Hazardous Substances Emergency Events Surveillance Overall, 3.6% (n52,373) of the total HSEES events ATSDR 5 Agency for Toxic Substances and Disease Registry (n566,588) reported from 2001 to 2008 were meth meth 5 methamphetamine related (Table 1). The highest percentage of meth lab events were reported in 2003 (n5524 events, 5.8% labs in cars or motor homes, or meth lab chemicals of all 2003 HSEES events) and 2004 (n5442 events, being transported). It is difficult to assign a meaning 5.7% of all 2004 HSEES events). The percentage of to the changing percentages over time, because the reported meth events decreased in 2005, when states number of participating states varied from 11 to 18 began applying sales restrictions on ephedrine prod­ during this period. ucts. The percentage further decreased in 2006, the More than 85.6% (n52,032) of illegal clandestine year the Federal Combat Methamphetamine Epidemic meth lab events occurred within one-fourth of a mile Act became effective nationwide.10 of a residence. The general land use immediately sur­ The majority of events (n52,102, 88.6%) occurred rounding an event recorded in the HSEES system can at fixed facilities (e.g., hotels, apartments, or sheds) be characterized by as many as two descriptors. The (Figure 1). The remainder of the events (n5271, general land use immediately surrounding the reported 11.4%) were related to transportation (e.g., mobile meth lab locations was identified as residential in 68.3%

Figure 1. Proportion of fixed-facility and transportation-related methamphetamine lab events, by year: ATSDR HSEES database, 2001–2008 Percent Percent

Year

ATSDR 5 Agency for Toxic Substances and Disease Registry HSEES 5 Hazardous Substances Emergency Events Surveillance

Public Health Reports / 2011 Supplement 1 / Volume 126 Meth Production Hazards and Reduction Efforts  119

Figure 2. Proportion of methamphetamine lab events by type of area in the vicinity of the event, by year: ATSDR HSEES database, 2001–2008 Percent Percent

Year Residential Commercial Agricultural/undeveloped

Industrial Recreational Other

ATSDR 5 Agency for Toxic Substances and Disease Registry HSEES 5 Hazardous Substances Emergency Events Surveillance of events (n51,621), commercial in 28.9% of events of events (n5442). The lowest number of people (n5686), agricultural or undeveloped in 28.5% of (n5108) evacuated was in 2008, which had 105 events, events (n5676), industrial in 2.7% of events (n564), the second-lowest number reported. recreational in 1.0% of events (n524), and other in Analysis of all HSEES events, 2001–2008, showed 2.7% of events (n564). The total (n53,135) is greater that 9.0% of the events resulted in reported victims. than the total number of events because more than Analysis of all meth events during the same interval one area could be reported per event. Meth labs have showed that nearly one-fourth (22.8%, n5541, range been most commonly found in residential areas, with from 37.0% in 2001 to 10.6% in 2006) resulted in vic­ an upward and progressive trend in the percentage of tims. Victims were defined as people who suffered at events in these areas from 2001 to 2008 (Figure 2). In least one adverse health effect or who died in associa­ recent years, a decreasing percentage of meth labs have tion with the clandestine drug lab chemical incident. been discovered in agricultural or undeveloped areas Of the 16,474 HSEES event victims reported from and in commercial areas. Because residential areas 2001 to 2008, 902 (5.5%) were related to clandestine can have higher population densities, and chemicals meth lab events. in meth labs can volatilize, explode, or catch fire, Most often, the victims were treated at the scene people in homes near the vicinity of a meth lab are by emergency medical personnel (6.8%, n561) or potentially at risk. they were observed and reported by an official even Meth lab events required evacuations more than though the victim did not seek medical treatment twice as often as all HSEES events during the 2001–2008 (42.9%, n5387). The percentage of all victims in the surveillance period (14.5% [n5343] of meth lab events HSEES database who did not seek medical treatment compared with 6.5% [n54,339] of all HSEES events). when officials observed symptoms was 6.5%, which is In the HSEES data, the highest percentage of evacua­ significantly different p( 50.001) when compared with tions was ordered in response to meth events in 2008 victims in meth events. In meth lab events, about one- (30.5%, n532), and the lowest in 2005 (8.3%, n525), third of victims (33.9%, n5306) were treated at the but the actual number of events with an evacuation hospital and released; 10.8% of victims (n597) were was relatively stable. The 2001–2008 clandestine meth admitted to a hospital for further treatment; 2.3% of lab events resulted in the evacuation of 3,596 people. victims (n521) received treatment from a private physi­ The greatest number of people (n51,210) evacuated cian; and 2% of victims (n518) died. Thirteen deaths was in 2004, which had the second-highest number occurred at the scene or upon arrival at the hospital,

Public Health Reports / 2011 Supplement 1 / Volume 126 120  Research Articles three deaths occurred after arrival at the hospital, and Table 2. Frequency of injury types reported two deaths occurred at unknown times. When these by victims associated with methamphetamine lab data are compared with all victims recorded in the events: ATSDR HSEES database, 2001–2008 HSEES system, the more severe medical outcomes of Victims being admitted to a hospital or dying are consistent: Injury typea N Percent 11.2% of all victims were admitted to the hospital, and 2.5% of all victims died. The most frequently reported Respiratory irritation 485 53.8 symptoms or health effects were respiratory irritation Headache 307 34.0 (53.8%), headache (34.0%), burns (15.4%), and eye Chemical burns 139 15.4 irritation (10.5%) (Table 2). Eye irritation 95 10.5 Sixty-one percent (n5552) of victims were official Gastrointestinal problems 75 8.3 responders to the incident, including police officers Dizziness/CNS effects 67 7.4 (55.1%, n5497), firefighters (5.9%,n 553), emergency medical services (EMS) personnel (0.2%, n52), and Trauma 34 3.8 unspecified responders (0.2%, n52). One-third of Skin irritation 32 3.5 victims (33.5%, n5302) were general public, and 5.1% Thermal burns 26 2.9 (n546) were employees. Shortness of breath 18 2.0 The percentage of meth lab events with victims in Other 16 1.8 the HSEES system consistently declined from 36.6% a 5 5 The HSEES system allows for as many as seven injury types to be (n 110) in 2001 to 11.4% (n 12) in 2008, with no reported for each victim. deaths reported in 2008. The percentage of police ATSDR 5 Agency for Toxic Substances and Disease Registry officers among victims decreased from 49.7% in 2001 HSEES 5 Hazardous Substances Emergency Events Surveillance to 35.3% in 2008, with a high of 70.9% in 2004 and CNS 5 central nervous system a low of 24.2% in 2007 (Figure 3). The percentage of firefighters and other official responders among victims declined slightly from 8.9% in 2001 to 5.9% in HSEES Program states affected by the meth lab 2008, and peaked at 11.l% in 2005. During the same epidemic used their HSEES data to target public period, the percentage of general public among victims health interventions. The outreach activities included increased from 29.1% (n552) to 47.1% (n58), with creating responder, public, and worker education a high of 72.3% (n524) in 2007. and awareness; educating santitation workers and law

Figure 3. Proportion of responder and general-public victims associated with methamphetamine lab events, by year: ATSDR HSEES database, 2001–2008 Percent Percent

Year

ATSDR 5 Agency for Toxic Substances and Disease Registry HSEES 5 Hazardous Substances Emergency Events Surveillance EMTs 5 emergency medical technicians

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enforcement personnel about meth lab refuse dan­ need and raise awareness about and recognition of gers; and participating in state policy advisory groups. clandestine meth labs and the associated hazards, NYS Examples of public health and legislative efforts to HSEES program staff helped facilitate awareness semi­ fight the meth lab epidemic in two states, Minnesota nars that targeted all agencies and groups that could and New York, follow. be involved in clandestine drug lab identification and response throughout NYS. Minnesota During development of the multi-agency presenta­ After observing emerging meth lab trends in the state tions, law enforcement identified a need for an easy-to­ from 1997 to 2000, the Minnesota HSEES Program read reference card. This need led to the development conferred with HSEES programs in Iowa and Missouri. of a visor card with relevant technical (visual indicators Data from these programs indicated that meth-related of a lab, products commonly found, and potential activity was moving north rapidly.12 Using HSEES data hazards) and contact information that was distributed and non-HSEES data in support of action, the Min­ to all law enforcement personnel in NYS. To increase nesota Department of Health obtained state funds in awareness among public health officials and decrease 2001 for a Meth Lab Program (MLP). The priority their chance of injury, NYS HSEES Program staff devel­ focus of the MLP was on education related to public oped guidance in 2003 about the physical dangers of health and safety hazards. As the MLP endeavored to responding to odor complaints that may originate from educate responders and the public on meth hazards, a clandestine meth lab. This odor-guidance document meth activity continued to increase, but the number of was distributed to all county environmental health offi­ related victims, especially first responders, declined. cials and to state environmental health staff in regional In January 2005, near the beginning of the legisla­ and district offices. tive session, Meth Day at the Capitol was held at the NYS HSEES Program staff made a presentation at Minnesota State Capitol. Many different groups, such the NYS Department of Health’s Environmental Health as government agencies, law enforcement agencies, Directors Fall Conference in 2003 and conducted a treatment providers, and community organizations, video-cast for state and local health department staff. developed presentations, displays, posters, and videos NYS HSEES Program staff also participated in the aimed at informing Minnesota lawmakers and the preparation of a report that focused on the effective­ general public about meth activity and the associated ness of three chemical deterrents that could be added community hazards. In conjunction with data from to agricultural anhydrous ammonia to prevent its sub­ other sources, HSEES data helped to show how meth sequent use in the production of meth. NYS HSEES activity had spread extensively in the state. The event Program staff provided data and testimony to the New assisted in further increasing public awareness of the York State Commission of Investigations that wrote issue. A bill that limited access to pseudoephedrine “Methamphetamine Use and Manufacture,” released and ammonia was passed by the Minnesota Legisla­ in 2005.14 NYS HSEES Program staff also provided ture, signed by Governor Pawlenty in May 2005, and information to the New York City Attorney General’s enacted in July 2005.13 Data analyses showed that, after Office for the report, “New York State Law Enforce­ implementation of the meth lab laws in July 2005, ment Council—2005 Legislative Priorities.”15 Following the number of newly discovered meth labs declined release of the reports, a comprehensive bill to combat almost threefold: from 95 in January–June 2005 to 33 meth labs was drafted, passed, and enacted into law in in July–December 2005. 2005.16 This legislation restricted sales of pseudoephed­ rine and created and/or increased penalties for crimes New York associated with the clandestine manufacture of meth. Clandestine drug labs, primarily meth labs, were first After the law was passed in 2005, the number of identi­ identified in New York State (NYS) in the 1980s and fied clandestine meth labs in NYS decreased to fewer then virtually disappeared until 2001. As other states than 20 per year in 2007 and 2008. were already dealing with the problems of clandes­ tine meth labs, NYS HSEES Program staff sought to DIScuSSIon learn from their experiences by conducting extensive research and contacting key personnel in those states. HSEES data show a surge and then a decline of meth They learned that the response to clandestine meth labs during the past decade, with fewer new labs labs needed to be multi-agency and that awareness reported after the implementation of state and federal training was needed by everyone who might respond laws. Because illegal production of meth often involves to a clandestine meth lab. To address the immediate use of volatile chemicals and makeshift equipment,

Public Health Reports / 2011 Supplement 1 / Volume 126 122  Research Articles these sites can be extremely dangerous and pose a ing that the first responders to arrive on scene, often health threat to the cooks, responders, and the public. police officers, would recognize the hazard and take Fires, explosions, spills, and volatilized chemicals are precautions. This increase in awareness and knowl­ hazards at meth lab sites and extremely dangerous edge might have contributed to reducing injuries to for humans and the environment.12 These hazards are responders. reflected in the type of injuries reported to the HSEES Law enforcement officials continue to identify clan­ system. More than half of the victims in HSEES events destine meth labs on a regular basis. Actions to decrease reported respiratory irritation, approximately one-third the number of labs and the resulting morbidity and of the victims reported headaches, and 15.4% reported mortality have been somewhat effective to date, but chemical burns. The HSEES data indicate the danger responders and the public must be aware that these labs of these sites: about 14.5% of HSEES-qualifying meth still exist and, therefore, the hazards still exist. Meth lab incidents required evacuations compared with 6.5% users will continuously look for “new and improved” of all HSEES events, and nearly one-fourth (22.9%) methods for making meth. Also, meth is the most of these incidents resulted in injuries compared with common drug manufactured in clandestine labs but is about 9.0% of all HSEES incidents.17 not the only drug manufactured in these clandestine Meth labs clearly pose a greater threat to responders settings. Data on clandestine drug lab incidents will than to other populations. Of the 902 victims, more help to identify changes in the drugs being made, in than 60% were responders: police officers, firefighters, the frequency of these incidents, and in the hazards and EMS personnel. For all HSEES incidents, less than involved. These data can be used to revise response 10% of victims were responders. Many of these labs protocols and training for responders and to educate (68.3%) were found in residential areas. Members of environmental health and public health professionals the general public who were at risk in meth lab events who address issues of decontamination and chemical included vulnerable populations, such as children and exposure. the elderly. About one-third of victims in meth lab events were members of the general public, similar to Limitations the percentage of general public victims in all HSEES There are limitations to the data that were collected incidents.18 These statistics demonstrate the risk that through the HSEES system. First, reporting to the meth labs pose to responders and to the communities HSEES system is not mandated, and states rely on other in which meth labs are found. mandated reporting sources. Meth lab details are par­ After 2004, the percentage of injuries to responders, ticularly difficult to obtain because of the confidentiality especially police officers, generally declined, while the surrounding pending legal actions. The requirements percentage of injuries to the general public continued for reporting clandestine meth labs differed among the to rise. This trend in injured-responder data might be participating states, leading to variations in the capture related to several factors, such as the implementation and availability of meth lab data by state. Staff from of local, state, and federal regulations that helped to the participating states also saw that many clandestine reduce the number of labs; increased awareness and meth lab incidents, although reported within the states, training for responders; the development of estab­ did not meet the HSEES case definition because they lished protocols that promoted caution and the use of were not acute events involving a release within the personal protective equipment, such as self-contained 72-hour period. For these reasons, the HSEES data breathing apparatuses and chemical-resistant clothing, do not provide a complete characterization of the during a meth lab response; and changes in meth lab magnitude of the clandestine meth lab problem in composition. First, state and federal laws restricting the participating states. It also is not known how well access to pseudoephedrine and other precursors to the available data reflect trends in states that did not meth appear to have been effective in reducing the participate in the HSEES Program. Data from the U.S. number of labs overall during the time period. This Drug Enforcement Administration (DEA) indicate that reduction in meth lab numbers most likely helped to there are large regional differences in the numbers reduce the number of injuries sustained by responders. of clandestine meth labs, with states in the mid- and Second, as described in the information from Min­ southeastern sections of the country generally reporting nesota and New York, efforts to educate responders higher meth lab discoveries.19 These limitations in the about best practices for responding to meth labs began data may be compounded by the changing number of in 2001, when the meth labs were clearly a growing participating states during the eight-year data-collection problem. These efforts involved many agencies and period, which might have affected the trends in meth organizations and were initially concentrated on ensur­ lab incidents collected by the HSEES system.

Public Health Reports / 2011 Supplement 1 / Volume 126 Meth Production Hazards and Reduction Efforts  123 concluSIonS evaluating change during early abstinence. J Stud Alcohol Drugs 2010;71:335-44. Despite these limitations, HSEES data served a valuable 3. Henry BL, Minassian A, Perry W. Effect of methamphetamine depen­ dence on everyday functional ability. Addict Behav 2010;35:593-8. role in initial identification of the surge in clandestine 4. Department of Health and Human Services (US), Substance Abuse meth labs and continued to be a tool to document and Mental Health Services Administration, Office of Applied Studies. 2007 national survey on drug use and health: national meth lab trends and the associated risks in the past results. Appendix B: statistical methods and measurements [cited decade. As the prevention activities in the states of 2008 Dec 30]. Available from: URL: http://www.oas.samhsa.gov/ Minnesota and New York indicate, the HSEES data NSDUH/2k7NSDUH/AppB.htm 5. Public health consequences among first responders to emergency allowed state health departments to identify an emerg­ events associated with illicit methamphetamine laboratories— ing problem relatively early. The recognition of the selected states, 1996–1999. MMWR Morb Mortal Wkly Rep 2000;49(45):1021-4. growing numbers and potential health risks of these 6. Witter RZ, Martyny JW, Mueller K, Gottschall B, Newman LS. clandestine meth labs provided evidence that helped Symptoms experienced by law enforcement personnel during meth­ amphetamine lab investigations. J Occup Environ Hyg 2007;4:895­ to garner support and secure funds for actions that 902. addressed the problem. 7. Martyny JW, Arbuckle SL, McCammon CS, Esswein EJ, Erb N. The sustained pressure from law enforcement, Chemical exposures associated with clandestine methamphetamine laboratories [cited 2010 Dec 14]. Available from: URL: http://www. public health, citizen groups, and others, along with nationaljewish.org/pdf/chemical_exposures.pdf state- and federal-directed chemical restrictions, has 8. Horton DK, Berkowitz Z, Kaye WE. The acute health consequences to children exposed to hazardous substances used in illicit metham­ likely contributed to continuing decreases of domestic phetamine production, 1996–2001. J Child Health 2003;1:99-108. clandestine meth production and associated injuries 9. Acute public health consequences of methamphetamine labora­ in the United States over the past several years. As tories—16 states, January 2000–June 2004. MMWR Morb Mortal Wkly Rep 2005;54(14):356-9. described in this article, a strong decline in meth lab 10. The Combat Methamphetamine Epidemic Act of 2005. Pub. L. No. activities was seen following enactment of meth-related 109-177, Sec. 701-756, 120 Stat. 192, 256-77 (March 9, 2006). 12–15 11. European Monitoring Centre for Drugs and Drug Addiction; legislation in Minnesota and New York. However, Europol. Methamphetamine: a European Union perspective in DEA data show that this problem has not disappeared the global context. 2009 [cited 2010 Dec 14]. Available from: URL: http://www.europol.europa.eu/publications/Joint_publica­ and could be on the rise again, with 7,485 labs report­ tions_on_illicit_drugs/Methamphetamine.pdf edly seized nationally in 2008 and 10,064 labs seized in 12. Anhydrous ammonia thefts and releases associated with illicit 2009.20 To protect public health, surveillance of clan­ methamphetamine production—16 States, January 2000–June 2004. MMWR Morb Mortal Wkly Rep 2005;54(14):359-61. destine drug labs and other chemical incidents should 13. Minnesota Statutes 2010, Sect. 35.051, 152.02, 152.0262, and continue. This surveillance will yield data that can be 152.136. 14. New York State Commission of Investigation. Methamphetamine use used to support public health efforts and legislation and manufacture. Final report. January 2005 [cited Dec 14 2010]. as trends change. Available from: URL: http://www.nyslec.com/pdfs/111804_final­ report.pdf 15. New York State Law Enforcement Council. 2005 legislative priori­ The Hazardous Substances Emergency Events Surveillance ties [cited 2010 Dec 14]. Available from: URL: http://nyslec.org/ Program represents the collaborative effort of many people whose pdfs/2005priorities.pdf cooperation is gratefully acknowledged. The authors thank Rita B. 16. Laws of New York, 2005, Chapter 394: Methamphetamine [cited Messing, PhD; Noreen Hughes, MS; Jenny K. Ehrlich, MPH; and 2010 Dec 14]. Available from: URL: http://criminaljustice.state their other partners in the state health departments who worked .ny.us/legalservices/ch_394_meth.htm hard to collect the data and perform the program activities 17. Drug Enforcement Administration (US). Environmental impacts of methamphetamine [cited 2009 Mar 6]. Available from: URL: reported in this article. http://www.usdoj.gov/dea/concern/meth_environment.html The findings and conclusions in this article are those of the 18. Centers for Disease Control and Prevention (US), Agency for Toxic authors and do not necessarily represent the views of the Centers Substances and Disease Registry, Hazardous Substances Emergency for Disease Control and Prevention or the Agency for Toxic Events Surveillance Program. Biennial report 2007–2008 [cited Substances and Disease Registry. 2010 Dec 14]. Available from: URL: http://www.atsdr.cdc.gov// HS/HSEES/annual2008.html 19. Scott MS, Dedel K. Clandestine methamphetamine labs, 2nd ed. Washington: Department of Justice (US), Office of Community REfEREncES Oriented Policing Services; 2006. Also available from: URL: http:// www.cops.usdoj.gov/ric/ResourceDetail.aspx?RID529 [cited 2010 1. Thompson PM, Hayashi KM, Simon SL, Geaga JA, Hong MS, Sui Y, May 21]. et al. Structural abnormalities in the brains of human subjects who 20. Drug Enforcement Administration (US). Maps of methamphet­ use methamphetamine. J Neurosci 2004;24:6028-36. amine incidents [cited 2010 Sep 21]. Available from: URL: http:// 2. Simon SL, Dean AC, Cordova X, Monterosso JR, London ED. Meth­ www.justice.gov/dea/concern/map_lab_seizures.html amphetamine dependence and neuropsychological functioning:

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